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Adiposity and insulin resistance in nondiabetic hemodialysis patients: effects of high energy supplementation^1,2,3

¹ From the Department and Institute of Physiology, National Yang-Ming University, Taipei (D-CT); the Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch (S-CH); and the Division of Nephrology, Department of Medicine and Immunology Research Center, Taipei Veterans General Hospital, Taipei, Taiwan (D-CT).

² Supported by grants from the National Science Council (NSC 95-2314-B-010-077 and 96-2628-B-010-001-MY3), Taipei Veterans General Hospital (V97S5-004 and V97C1-093), and Buddhist Tzu Chi General Hospital, Taipei Branch (TCRD-TPE-95-45).

³ Address correspondence to D-C Tarng, Department and Institute of Physiology, National Yang-Ming University and Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital. No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan. E-mail: dctarng{at}vghtpe.gov.tw.

Background: In contrast to the general population, a higher body mass index is associated with better survival among hemodialysis patients. Theoretically, high energy supplementation in these patients ought to lead to weight gain over time, but the benefits of this strategy are unclear.

Objective: The objective was to assess whether high energy supplementation in nondiabetic hemodialysis patients might adversely affect insulin resistance—a known risk factor for cardiovascular disease.

Design: We first investigated the association between body fat mass and insulin resistance (homeostasis model assessment of insulin resistance; HOMA-IR) in nondiabetic hemodialysis patients in a cross-sectional analysis (study 1). Of the 106 individuals studied, 55 were randomly assigned to either high energy supplementation (an extra 475 kcal/d; n = 28) or not (n = 27) for 12 wk to assess prospective changes in body fat mass and insulin resistance (study 2).

Results: In study 1, body fat mass (P < 0.05) and C-reactive protein (CRP) (P < 0.05) each contributed independently to HOMA-IR. In study 2, 41 patients completed the study. The 20 patients who received high energy supplementation had a significantly greater increase in body fat mass (P < 0.05), CRP (P < 0.05), and HOMA-IR (P < 0.001) than did the 21 controls.

Conclusions: Body fat mass and CRP are primary determinants of insulin resistance in nondiabetic hemodialysis patients. High energy supplementation, because it increases adiposity and inflammation, exacerbates insulin resistance. A long-term study is needed to clarify the metabolic effects of high energy supplementation on cardiovascular disease outcomes in hemodialysis patients.